Inspection on 11/06/07 for Cecil Road (12)

This inspection was carried out on 11th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 35 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cecil Road (12) 01/09/08

Cecil Road (12) 28/09/06

Cecil Road (12) 02/02/06

Cecil Road (12) 12/07/05

Cecil Road (12) 02/03/05

Cecil Road (12) 29/06/04

Cecil Road (12) 01/03/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Cecil Road (12) 12 Cecil Road Ilford Essex IG1 2EW Lead Inspector Harbinder Ghir Unannounced Inspection 11th June 2007 10:00 Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cecil Road (12) Address 12 Cecil Road Ilford Essex IG1 2EW 020 8514 8689 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) mgauri@hotmail.com Mrs Veena Mehta Mrs Sumiran Sharma Mrs Veena Mehta Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Mild to moderate level of disability. Date of last inspection 28th September 2006 Brief Description of the Service: 12 Cecil Rd is a residential home registered to care for three younger adults with learning disabilities. The home is a terraced house in a residential area close to Ilford town centre, with good public transport links, a park and other community facilities. The house is an ordinary domestic property. All the service users occupy single bedrooms. Shared facilities include a lounge and a small dining area in the conservatory. A small garden is also available for the service users enjoyment. A bedroom is located on the ground floor as well as a toilet/ shower. There are two bedrooms upstairs plus a staff sleeping in room and a bathroom/toilet shared between the service users upstairs. The manager and staff ensure the service users enjoy an active social life via membership of various groups and organisations. All of the service users attend day care services. The staff take service users out on a regular basis to local pubs, cinema, restaurants as well as their chosen places of worship. Family and friends are welcome to visit at any time. A Statement of Purpose and Service User Guide are available upon request. The range of fees charged are from £787 - £687 per month. Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken by Regulation Inspector Harbinder Ghir. The inspection took place over two days on the 11th June and the 12th June 2007 between 10.00am and 3.00pm and 2.00pm and 4.30pm. The deputy manager was available throughout the time to aid the inspection process. The registered manager was available during the second day of the inspection. During the inspection the inspector was able to talk to one resident, two members of staff. Three relatives and two key workers for two residents that attend day centres were contacted via telephone. As part of the inspection the inspector toured the home, read records of people who use the service and examined documents in relation to the management of the home. At the end of the inspection the inspector was able to provide feedback to the manager and deputy manager of the home. Three requirements were set at the previous inspection and for two of these the timescales have been met. The remaining one requirement has not been met and will be restated with a revised timescale. Thirty requirements and three recommendations have been made at this inspection. The inspector would like to thank everyone involved in the inspection process. What the service does well: What has improved since the last inspection? Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 6 The adult protection policy and procedure have been reviewed and updated to ensure staff are aware of the procedure to follow in the event of an allegation being made. A log of all supervision provided is kept for all members of staff. What they could do better: The Statement of Purpose, the Service User Guide and care plans should be considered to be provided in other formats, such as pictorial, video or DVD, which would make them more appropriate to the communication needs of residents. The décor of the home does not provide a safe and clean living environment and requires urgent attention. Care plans must be made available in formats, which are suitable to the communication needs of residents. The home needs to review its medication procedures and policy when transferring medication to residents when they are away from the home for short breaks visiting relatives. The home to supply the Commission for Social Care Inspection a report in respect of any review conducted for the purpose of improving the quality of care provided at the home, and make a copy of the report available to residents. Ways to minimise the risks of infection need to be revisited by the manager as a priority. Health and safety risks posed to residents throughout the home need to be reviewed by the manager. A daily log of food intake for each resident needs to be maintained by the home to monitor his or her nutritional intake. This is to be made a priority for residents who are diabetic. Staff training to be provided to ensure staff are equipped with the skills to meet the needs of residents, and training in Adult Protection to be prioritised by the home. Staff recruitment practices need to be more robust to ensure the safety and protection of residents. Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 Quality in this outcome area is good. The Statement of Purpose must be updated to reflect the correct staffing structure of the home. The Service User Guide must be amended to comply with the requirements of the Care Standards Act 2001. Residents’ needs are fully assessed prior to admission and residents are ensured that their needs can be met by the service. All prospective residents are given opportunities to visit the home and can stay overnight. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and Service User Guide included very detailed information about the service and how it intends to meet residents’ needs. Both documents were presented in text format, which was not suitable to the needs of people who use the service. It is Requirement 1 that both documents are provided in formats suitable to residents for whom the service is intended. The Statement of Purpose must be updated to include an accurate reflection of the staff working at the home. The document included details of staff that no longer work at the home and did not include details of new staff in post such as the deputy manager. It is Requirement 2, that the Statement of Purpose is updated to include an accurate reflection of the service’s staffing Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 10 structure. The Service User Guide did not include a copy of the complaints procedure and views of residents living at the home. It is Requirement 3 the document is updated to include the above. There have been no new admissions to the home. The three residents residing at the home moved into the home in 1997/1998. Therefore standard two could not be fully tested. Evidence was seen of a comprehensive pre-admissions procedure and assessment the home would follow for new prospective residents. All residents files examined included pre-admission assessments and assessments from other multi professionals and agencies. The home offers trial visits and overnight stays. Staff training files examined and daily case recording sheets evidenced that staff are equipped with the knowledge and skills to meet residents’ needs. Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 Quality in this outcome area is adequate. Residents assessed needs are reflected in their individual plan, however shortfalls were found in identifying residents changing needs. Residents are supported to make active choices and decisions throughout their daily living. Personal information is not always safely and securely stored This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plan files were closely examined. Care plans were comprehensive and covered all aspects of physical, mental and emotional health. Key areas included personal information, medical, environmental, physical and psychological health, personal finances, community participation, interests and hobbies. One care plan viewed did not include the changing mobility needs for one resident. On touring the building a plastic stool was found in the bathroom. On speaking to the accompanying member of staff she stated “I use this to sit a resident on when I assist her to give a shower in the bath, because Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 12 the resident finds it difficult to get in and out of the bath”. The care plan did not include any information regarding the difficulties with getting in and out of the bath and risk assessments did not identify risks in relation to bathing. This practice was identified as dangerous and unsafe, putting the resident and member of staff involved at risk. It is Requirement 4 that the home identify residents’ changing needs and all risk assessments are updated and recorded on the care plan to ensure the safety of residents. Care plans did include some pictorial format information but the remaining information was still not appropriate to the communication needs of residents. It is Requirement 5 that the care plan is made available in a format that the resident can understand. Care plans were devised by staff and there was no evidence of residents contributing to the compilation of the care plan. It is Requirement 6 that care plans are drawn up with the involvement of the resident together with family, friends and relevant agencies where appropriate. The service is in the process of devising “about me” booklets, which will include person centred information. Risk assessments were completed for all residents and risk areas covered included challenging behaviour, absconding, self-harm, mental health, and epilepsy. Risk assessments were reviewed every six months and earlier if required. However shortfalls were found in identifying changing risks and new risks as mentioned above. Please see requirement 4. The deputy manager held monthly one to one sessions with residents to identify any concerns residents had in regards to their care and the way their needs were met. Questions in these sessions included “Things you like now, things you would like to happen, things you don’t like.” In addition monthly meetings were also held between residents’ link and key workers to identify any concerns regarding the care of residents. Residents were involved in the daily running of the home as far as their abilities allowed. Daily activity records evidenced that residents were involved in preparing their meals, completing household tasks such as laundry, hovering and ironing. They were also given opportunities to express their feelings in monthly one to one sessions. Good relationships between staff and residents were observed during the inspection. A relative of a resident spoken to stated, “The staff are very caring and the care provided at the home is first class. “I have no complaints and the carers are very good.” Another relative informed “ I haven’t had anything to complain about, staff are very good, and the care appear to be good.” Residents’ personal information was not safely and securely stored. A letter with details of a resident’s healthcare information was found to be stored on the homes notice board positioned in the hallway. Information relating to Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 13 residents personal care must be kept confidential and stored appropriately. This is Requirement 7. Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is adequate. Residents are provided with adequate opportunities to be able to participate in community activities. Residents are provided with a variety of food but options for specialist diets are limited. Residents are encouraged to maintain relationships with family and friends. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The activity programme for each resident evidenced residents participated in a wide range of activity programmes. All residents attended specialist day centres five days a week where they completed activities such as gardening, bowling and leisure activities. Staff supported residents to go out to pubs, restaurants and cinemas. The recording of daily activity programmes were not completed in full and no recording was found for some days. It is Recommendation 1 that all activities residents participate in are recorded in full on a daily basis to ensure staff are aware of what activities residents have Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 15 participated in. Resident’s religious and spiritual needs are promoted by the service as staff support all three residents to attend church on a weekly basis. A four weekly menu was seen which evidenced that a wide range of meals were provided by the service. Residents could choose something different, which was not on the menu if this was their preference. One resident spoken to stated, “I like the meals at the home, I like cheese pie.” However the menu did not specify alternative choices for those residents with specialist diets such as diabetes. It is Requirement 8 that alternative menu options are specified on the menu to cater for those resident with specialist diets. On a tour of the kitchen fresh fruit and foods were found in the kitchen. Only one chopping board was found to cut vegetables and meat products which would increase the risk of infection. It is Requirement 9 that adequate kitchen equipment is provided to reduce the risks of infection. A log of fridge, freezer and food temperatures were seen, which was not consistently completed by staff and no recordings were found for some weeks. It is Requirement 10 to reduce the risks of infection and ensure appliances are in working order maintaining the correct temperatures a daily log of temperatures is recorded consistently. Evidence was seen in care plan files of completed nutritional screening assessments for residents. However, these assessments were not always followed. For one resident who is diabetic her care plan clearly identified a assessed need for monthly weight checks to be completed. On viewing the care plan the last monthly weight check was completed in January 2007. It is Requirement 11 that residents’ nutritional needs and risks are adequately met and monthly weighing in checks are completed. Residents menu choice was recorded in daily recording by staff but the amount they eat was not recorded which did not ensure staff were aware of the amount of residents nutritional intake. It is Requirement 12 that residents nutritional intake is recorded to ensure their nutritional needs are met. This to be made a priority for residents with specialist healthcare led dietary needs. Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21 Quality in this outcome area is adequate. The healthcare needs of residents are met on a day-to-day basis but prompt referrals are not made to healthcare professionals. Residents receive personal support in the way they prefer. Medication administration practices are not safe. The needs and wishes of residents in the event of death are identified and recorded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents have a detailed plan of their daily routine including what support is needed in relation to personal hygiene due to their level of care needs. All residents have a designated key worker to promote their privacy and dignity, but personal care is not always provided in private. On tour of the building a sliding door to the ground floor bathroom/shower room did not shut fully and could not be locked. Residents continued to use the bathroom with their rights to privacy breached. Please see Requirement 21. Personal support takes account of individual preferences and residents’ choice of dress and Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 17 appearance is respected. A resident spoken to informed “I choose my own clothes from catalogues, which the manager orders for me, I choose what I want to wear.” Care plans evidenced that residents healthcare needs are recognised and met. Evidence was seen of involvement of multli-disciplinary healthcare professionals such a dentists, chiropodists and GP’s. However, prompt healthcare referrals were not made to meet the changing needs of residents. As highlighted earlier in this report a resident was identified as having difficulty in getting and out of the bath and a plastic stool purchased by a member of staff was used to aid her in this process. No evidence was found of a referral made to an Occupational Therapist to complete a specialist assessment and identify specialist equipment to assist the resident and staff. It is Requirement 13 that residents’ healthcare is monitored and potential complications and problems are identified and dealt with at an early stage, including prompt referrals to appropriate specialists. The practices of medication administration did not ensure the safety of residents. The service used the Monitored Dosage system. There were no controlled drugs on the premises and all medication was stored in a locked cupboard. On viewing the Medication Administration Records it was found that entries for some days were missing and appropriate codes for missing entries were not recorded. A audit of the medication revealed that six tablets were missing and six entries had not been completed. One cream for a resident did not include a date of opening. It is Requirement 14 that the Medication Administration Records are recorded and signed in full to evidence medicines administered to residents. It is Requirement 15 that any medication in the form of creams includes a date of opening. A resident’s insulin was found in the kitchen fridge and was not in a locked container. It is Requirement 16 that any temperature-controlled drugs are stored in a locked container. Staff supported all three residents to administer their medication. However, on viewing residents files only two signed consent forms by residents to give the service permission to administer medication were found. It is Requirement 17 that signed consent is gained from all residents who are unable to administer medication. The service did not have a policy on any medication leaving the home. In compliance with Care Homes Regulations 2001 and The Administration & Control of Medicine Guidance the home must produce a written policy that includes the procedures to be followed and the precautions to be taken, including a witness to the transfer, when transferring medication to be taken out of the home. This is Requirement 18. There was also no record of signatures by family receiving the medication and staff accepting medication. As with any medication taken out of the home a signature of the person accepting receipt and any return is required. This is Requirement 19. Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 18 All members if staff have undergone training in medication administration and have undergone specialist training in insulin administration. Steps have been taken to find out the wishes of residents in the event of their death, including contacting relatives or representatives. Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate. The home has a comprehensive complaints policy and procedure. A complaints logbook must be maintained by the home, no matter how minor complaints are must be logged. There is a comprehensive adult protection procedure in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is clear, concise and easy to follow and is also displayed around the home. A logbook of complaints is not kept by the service. The deputy manager informed that all complaints are resolved before they escalate any further. Any complaint or dissatisfaction however small or minor must be logged in a complaints logbook to demonstrate the concerns raised and how the service actioned and resolved them and identify any patterns emerging. This is Requirement 20. The home has comprehensive procures and policies on adult protection. Two members of staff were spoken; both members of staff were able to identify types of abuse and the protocols they would follow in reporting the incidents of abuse. The inspector was assured staff practices would ensure the safety of residents. Staff have not been provided with up to date training on adult protection within the last two years. One member of staff spoken to when asked about her training needs stated “Yes I could do with more training.” Four Supervision records seen also identified staff commenting on more training to be provided for them. No records were seen of any training in adult Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 20 protection training booked for staff. It is Requirement 21 all staff receive up to date training in adult protection. Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30 Quality in this outcome area is poor. The décor of the home does not provide a safe and clean living environment and requires urgent attention. The home does not reduce the risks of infection by its practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service’s Statement of Purpose state “ The physical environment of the home is designed for residents’ convenience and comfort. In particular, we will do the following; Maintain the building and grounds in a safe condition, and make detailed arrangements for the communal areas of the home to be safe and comfortable.” During a tour of the building it was identified the décor and furnishings did not provide a comfortable environment for residents. The dining table in the conservatory was unsteady. The lighting in the lounge was dull resulting in the room being very dark. The carpet in the lounge, conservatory and office was badly stained and worn. The upstairs bathroom required urgent Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 22 attention as the wallpaper was peeling off and a serious of mould was found around the rim of the bath. One relative spoken to also stated, “The bathroom upstairs could do with a refurbishment.” The sliding door to the bathroom of the ground floor did not shut. A resident using a zimmer frame was observed using the ground floor bathroom and could not slide the door across for it to open when wanting to come out. When the deputy manager was asked why the slide door was not fixed for it to shut she replied, “ The resident likes to have the door slightly open when using the bathroom”. When the resident was asked about the door she replied “There is something wrong with the hinges of the door, it does not shut.” This breaches the rights of residents right to privacy and dignity when completing personal care tasks. It is Requirement 22 that the registered manager pays urgent attention to the décor and furnishings of the home and provides a safe and comfortable environment in requirement with the Care Standards Act 2001 and Care Home Regulations. The bathroom also stored a drying rack and cleaning equipment. It is Requirement 23 that the bathroom is kept free from household equipment. The Office located on the first floor of the property includes an office, which staff also use as sleeping in room. Staff were currently sleeping on a mattress, as the bed frame was broken. It is Requirement 24 that staff are provided with an adequate bed with a frame to provide sufficient sleeping equipment for staff when on duty. The risks of infection were not reduced by the service. There were no paper towels or soap dispensers in both bathrooms and no swing top in the bathroom upstairs on the first floor. It is Requirement 25 that hand washing equipment and swing top bins are provided throughout the home to reduce the risks of infection. Whilst completing the inspection the inspector observed mice in the kitchen and lounge. The registered manager is to make urgent contact with the Environmental Health Department. This is Requirement 26. Household hazardous products were found in an unlocked cupboard in the first floor bathroom and under the kitchen sink and were found left out in the conservatory. All parts of the home to which residents have access to must be so far reasonably practicable made free from hazards to their safety and unnecessary risks to residents are identified and so far as possible eliminated, this is Requirement 27. Two residents’ bedrooms were seen during the inspection, which were personalised. One resident had collected ornaments and displayed them in her room. All three residents held keys to their bedrooms. The property has a driveway at the front of the house and a rear garden. The garden to the house stored household rubbish and general household waste, which increased the risk of infection. It is Requirement 28 that external grounds are made free from household waste to ensure residents live in a safe and comfortable environment. The garden area was very basic and the service Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 23 did not provide adequate garden furniture for residents to use. One relative spoken to stated “I would really prefer if the residents were encouraged to go out into the garden, and is made more accessible with a nice sitting are”. It is Recommendation 3 the garden is made more attractive and adequate garden furniture is provided for residents. Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is poor. The residents are not protected by the homes recruitment practices. Staff receive supervision on a regular basis. There is a good match of qualified staff and stable staff team but staff have received limited training in the last two years. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four staff files were closely examined. Staff training records evidenced that all four members had only received training on the use of medicines in care homes in 2006. No other training had been provided by the service since 2004 and no evidence was seen of any future training courses being booked for staff. Staff on commencement of employment receives training including training in Manual Handling, Risk Management, Basic Food Hygiene, Basic First Aid, Basic Health and Safety, Adult Protection and Epilepsy Awareness. One member of staff spoken to during the inspection stated, “ I could do with more up to date training.” Staff supervision records also identified staff identifying more training to be provided to meet their training needs. It is Requirement 28a that up to date training and refresher courses are booked for all staff to Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 25 ensure they are equipped with the skills and knowledge to meet the needs of residents. Staff rotas evidenced there are sufficient numbers of staff on duty to meet the needs of residents. There are always two members of staff on duty during the day and one sleep in member of staff on during the night. The service has a permanent staff team and no agency staff are used. Staff were seen to interact and chat with the resident present positively. Staff files evidenced that robust recruitment checks did not take place before the commencement of employment. Four staff files were closely examined. Two references were found on one file. Two files had one reference on file and one file had no references on files. To ensure the safety of residents’ adequate recruitment checks and two references must be obtained for all employees before the commencement of employment. This is Requirement 29. Criminal records Bureau Checks, job descriptions and contracts of employment were all issued to staff. The service has a ratio above 50 of NVQ qualified staff. Staff supervision and appraisal records seen evidenced that all staff were supervised regularly. Staff meetings are held on a monthly basis, also give an opportunity to staff to express any views and concerns they have. No staff appraisal system was in place to review staff performance. It is Recommendation 2 that an annual appraisal system is implemented. Professionals and relatives spoken to spoke very highly of the staff team. A day centre key worker for one resident spoken to stated “the staff at the home are fine and “x” is always well equipped with money and things he needs throughout the day by the staff at the home”. One relative commented, “the staff are helpful and kind and I don’t have any concerns, my sister is well looked after. Another relative stated, “we have no complaints and the service is first class”. Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate. Residents’ benefit from an experienced manager who recognises their needs and adequately manages the home. Systems for service user consultation have been implemented The welfare of staff and service users is not promoted by the homes policies and procedures at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager of the home has completed her NVQ level 4. She has extensive experience of working with individuals with learning disabilities. The registered manager communicates a clear sense of direction, leadership and openness. Staff said they felt well supported and the manager Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 27 was approachable. A member of staff stated that “the manager is very good at resolving issues very quickly and easy to talk to. One relative stated “ we have a very good relationship with the manager and we treat her like she is our family.” Quality assurance surveys have been implemented by the service and evidence was seen of some completed surveys. No other evidence was seen of completed surveys by stakeholders or family and timescales had not been set in which surveys would be collected and collated. It is Requirement 30 that quality assurance surveys are completed regularly and timescales are set. That results are then communicated to residents and family and a copy of the results is made available to the Commission for Social Care Inspection. Health and Safety check were not completed in line with the Care Home Regulations. Evidence seen identified that certificates regarding health and safety checks had expired. It is Requirement 31 that all Health and Safety checks are made and certificates acquired to evidence that regular servicing of boilers and central heating systems are under contract by a competent person who are members of the Council of Registered Gas Installers (CORGI) and maintenance of electrical systems and electrical equipment is in place. Evidence was seen of water temperatures checks at all outlets throughout the home on a monthly basis. Records seen evidence that fire drills are completed four times a year and monthly fire alarm tests take place. There was no records to evidence the service had a up to date fire assessment. It is Requirement 32 that the service has a fire assessment to ensure the safety of residents and staff. Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 3 26 3 27 1 28 3 29 1 30 1 STAFFING Standard No Score 31 X 32 1 33 3 34 1 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 3 3 1 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 1 3 1 X 2 X X 1 x Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 29 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4, 5 Requirement The Statement of Purpose and the Service User Guide are provided in formats suitable to the communication needs of people who use the service. The Statement of Purpose must reflect the current staffing structure at the home. The Service User Guide must include a copy if the complaints procedure and views of residents residing at the home. The registered person must ensure that all risk assessments are reviewed and updated for each service user when needs change. Repeated Requirement. Previous Timescale of 31/01/07 not met. Care plans are provided in formats, which are suitable to the communication needs of residents. care plans are drawn up with the involvement of the resident together with family, friends and relevant agencies where appropriate. Timescale for action 31/08/07 2 3 YA1 YA1 4 Sch 1. 5 31/08/07 31/08/07 4 YA9 13 31/07/07 5 YA6 15 31/08/07 6 YA6 15 31/08/07 Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 30 7 8 YA10 YA17 17 12 9 10 YA17 YA17 13, 16 13 11 YA17 YA19 13 12 YA17 13 13 YA19 13 14 YA20 13 15 16 17 YA20 YA20 YA20 13 13 13 Information relating to residents must be kept confidential and stored appropriately Alternative menu options must be specified on the menu to cater for those resident with specialist diets. Adequate kitchen equipment must be provided to reduce the risks of infection. To reduce the risks of infection and ensure appliances are in working order, a daily log of fridge, freezer and food temperatures must be recorded consistently. Residents’ nutritional needs and risks are adequately met and monthly weighing in checks are completed Residents nutritional intake is recorded to ensure their nutritional needs are met. This to be made a priority for residents with specialist dietary needs. Residents’ healthcare is monitored and potential complications and problems are identified and dealt with at an early stage, including prompt referrals to appropriate specialists. Medication Administration Records are recorded and signed in full to evidence medicines administered to residents. Any medication in the form of creams includes a date of opening. Temperature-controlled drugs are stored in a locked container inside the fridge. The registered manager must gain written signed consent from all residents to give permission for staff to support them to take their medication. DS0000025892.V340068.R01.S.doc 31/07/07 31/07/07 31/07/07 31/07/07 31/07/07 31/07/07 31/07/07 31/07/07 31/07/07 31/07/07 31/07/07 Cecil Road (12) Version 5.2 Page 31 18 YA20 13 19 YA20 13 20 YA22 22 21 22 YA23 YA24 13 23 23 24 YA24 YA24 23 23 25 YA30 13, 23 26 YA30 13, 23 In compliance with Care Homes Regulations 2001 and The Administration & Control of Medicine Guidance the home must produce a written policy that includes the procedures to be followed and the precautions to be taken, including a witness to the transfer, when transferring medication to be taken out of the home. A log must be kept of any medication taken out of the home and a signature of the person accepting receipt and any return is required Any complaint or dissatisfaction however small or minor must be logged in a complaints logbook to demonstrate the concerns raised and how the service actioned and resolved them and identify any patterns emerging. All staff to receive up to date training in adult protection. The registered manager must attend to the décor and furnishings of the home and provides a safe and comfortable environment in requirement with the Care Standards Act 2001 and Care Home Regulations. The ground floor bathroom is kept free from household equipment. Staff are provided with an adequate bed with a frame to provide sufficient sleeping equipment for staff when on duty. hand washing equipment such as paper towels, soap dispensers and swing top bins are provided throughout the home to reduce the risks of infection. The registered manager to make urgent contact with the Environmental Health DS0000025892.V340068.R01.S.doc 31/07/07 31/07/07 31/07/07 31/08/07 31/08/07 31/08/07 31/08/07 31/07/07 30/06/07 Cecil Road (12) Version 5.2 Page 32 27 YA24 YA30 13, 23 28 YA24 23 28a YA32 18 29 YA34 Sch 2. 19 30 YA39 24 31 YA42 23 32 YA42 23 Department regarding the presence if mice at the property. All parts of the home to which residents have access to must be so far reasonably practicable made free from hazards to their safety and unnecessary risks to residents are identified and so far as possible eliminated External grounds are made free from household waste to ensure residents live in a safe and comfortable environment. Up to date training and refresher courses must be booked for all staff to ensure they are equipped with the skills and knowledge to meet the needs of residents. To ensure the safety of residents’ adequate recruitment checks and two references must be obtained for all employees before the commencement of employment. Quality assurance surveys must be completed regularly and timescales are set within which survey are collected and collated. That results are then communicated to residents and family and a copy of the results is made available to the Commission for Social Care Inspection. Health and Safety checks must be made and certificates acquired to evidence that regular servicing of boilers and central heating system are under contract by a competent person who are members of the Council of Registered Gas Installers (CORGI) and maintenance of electrical systems and electrical equipment is in place. The Registered manager ensures the premise has a fire risk assessment to ensure the safety DS0000025892.V340068.R01.S.doc 31/08/07 31/08/07 31/07/07 31/08/07 31/08/07 31/08/07 31/08/07 Cecil Road (12) Version 5.2 Page 33 of residents and staff. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA12 Good Practice Recommendations It is recommended that all activities residents participate in are recorded in full on a daily basis to ensure staff are aware of what activities the residents has participated in. It is recommended that an annual appraisal system is implemented It is recommended the garden is made more attractive and adequate garden furniture is provided for residents. YA32 YA24 Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cecil Road (12) DS0000025892.V340068.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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